Provider Enrollment & Credentialing Specialist

Paylocity; Grants, Northern (NM, KY); Hybrid; USD 60,000 - 76,000; Full time

Job summary

Paylocity is seeking a Provider Enrollment Specialist to manage enrollment and re-enrollment of physicians, APPs, and other clinical staff with Medicare, Medicaid, and commercial payers. The role ensures timely, compliant enrollment to support reimbursement and patient care.

You will coordinate with credentialing teams, CAH enrollment, and payer portals; monitor revalidation, troubleshoot enrollment issues, and generate status reports for leadership.

Qualifications

• Associate’s degree in Healthcare Administration, Business, or related field required.
• Minimum 2–3 years of provider enrollment, credentialing, or medical billing experience.
• Familiarity with Medicare PECOS, CAQH, NPPES, and state Medicaid enrollment processes preferred.
• Strong understanding of HIPAA, Medicare regulations, and payer contracting guidelines.
• Proficiency with enrollment software, EHR/PM systems, and Microsoft Excel.

Responsibilities

• Prepare, review, and submit enrollment applications for Medicare, Medicaid, and commercial payers.
• Coordinate CAH-specific enrollment requirements including facility and provider enrollments.
• Gather documentation (licenses, certifications, malpractice insurance, DEA, NPI).
• Track application status and follow up with payers to secure timely approvals.
• Maintain enrollment records in internal systems and payer portals.
• Monitor revalidation schedules to prevent lapses in billing privileges.
• Assist with troubleshooting claim denials related to enrollment issues.
• Serve as liaison between hospital, providers, and payers to resolve enrollment issues.
• Conduct regular audits of enrollment data for accuracy and compliance.
• Stay current with payer policies and Medicare regulations.
• Support onboarding of new providers and locum tenens staff.
• Generate reports on enrollment status and timelines for leadership.

Skills

Provider enrollment experience

Credentialing

HIPAA knowledge

Excel proficiency

Attention to detail

Interpersonal communication

Education

Associate’s degree in Healthcare Administration, Business, or related field

Bachelor’s degree

Tools

Enrollment software

EHR/Practice Management systems

Microsoft Excel

Job description

Paylocity is seeking a Provider Enrollment Specialist to manage enrollment and re-enrollment of physicians, APPs, and other clinical staff with Medicare, Medicaid, and commercial payers. The role ensures timely, compliant enrollment to support reimbursement and patient care.

You will coordinate with credentialing teams, CAH enrollment, and payer portals; monitor revalidation, troubleshoot enrollment issues, and generate status reports for leadership.